In the management of the patient with an intra-abdominal recurrence of colorectal carcinoma, surgery remains the primary mode of therapy when cure or significant palliation is anticipated. Improved surgical techniques have allowed safe resection of metastases in the liver, and in selected patients, this treatment produces 5-year survival rates approaching 50%. In the patient with recurrent disease locally, surgery again provides the only means of cure and also plays a significant role in palliation. Aggressive resection with generous surgical margins in patients with contained disease may yield 5-year survival rates approaching 35%. Surgical intervention for obstruction, perforation, and other anatomic or physiologic compromise can improve the quality of life of the patient with intra-abdominal recurrence.